anagrelide hydrochloride: clinical use

Prescribing considerations

• Initiation and supervision should be by a clinician experienced in essential thrombocythaemia.
• Assess cardiovascular status before treatment, including ECG and echocardiography; serious events have occurred even without known pre-existing cardiac disease.
• Assess benefit and risk carefully in mild hepatic or renal impairment and in people with QT-prolongation risk factors.
• Avoid abrupt withdrawal; arrange frequent platelet monitoring during interruptions or discontinuation.
• Paediatric evidence is very limited and requires specialist risk-benefit review.

Contraindications and cautions

• Hypersensitivity to anagrelide or an excipient.
• Moderate or severe hepatic impairment.
• Moderate or severe renal impairment.
• The selected capsule contains lactose and should not be used in specified rare hereditary disorders of galactose metabolism or absorption.

Monitoring

• Full blood count, including platelet, haemoglobin and white-cell counts.
• Liver and renal function.
• Potassium, magnesium and calcium; correct relevant abnormalities.
• Clinical cardiovascular assessment with ECG or echocardiography when indicated.
• Symptoms or signs of pulmonary hypertension or other cardiopulmonary disease.
• Frequent platelet counts if treatment is interrupted or withdrawn.

Clinical pharmacology

Anagrelide suppresses megakaryocyte maturation and platelet formation and inhibits cyclic AMP phosphodiesterase III. It is absorbed orally, metabolised mainly through CYP1A2 to an active metabolite and has a short plasma half-life.

Formulation and product differences

• The selected Sandoz product is a hard gelatine capsule containing lactose.
• Capsules must be swallowed whole and must not be crushed or dispersed in liquid.
• The selected product is supplied in a moisture-protective bottle with desiccant and should be kept tightly closed in its original packaging.

Capsule

Route: Oral

Strengths: 0.5 mg